Understanding and treating
chronic shame: A relational/neurobiological approach
by Patricia A. DeYoung
Published by Routledge, February 2015
Reviewed by Emma Philbin Bowman
I liked this book so much that I sent a fan email to the author extolling its virtues, before suggesting to Inside Out that I review it here. Now, when I come to do that, I feel shy, clumsy, worried I will over-expose myself in some unplanned way in how I write about it. All of which speaks to this theme, and this book.
Shame has never been a topic or even a word that I have been willing to get too close to. I have always been just about sufficiently ‘cool’ not to identify with it. Shame was for other people. I was good – or thought I was – at ‘toughing it out’, glossing over embarrassment, and didn’t stop to count the cost. In fact, I didn’t even notice there was one, every time I felt inwardly humiliated, hurt, lonely, lost, rejected, but pretended everything was fine.
So I came to the book sideways, thinking I was going to read about others, and it blindsided me. Patricia DeYoung defines shame in entirely relational terms and suggests it is an experience triggered by misattunement: “Shame is the experience of one’s felt sense of self disintegrating in relation to a dysregulating other” (18). This makes Understanding and treating chronic shame a book not just for those interested in the topic of shame, but for any of us concerned to understand how early misattunement affects our relational capacities and ways of being over the course of a life.
DeYoung explains that she speaks of a self “disintegrating in relation” (19), in an attempt to capture “the most essential experience of a shamed self, the self’s relational experience before it is given meaning” (19) – that is, before we form ideas and interpretations about what ‘goes wrong’ with another. She argues that very few clients who suffer from chronic shame specifically remember explicit shaming moments. Instead, what they have in common is consistent failures of attunement. Shame is thus less a self-image problem than we usually imagine. Instead, “failure of affect attunement” (24) and its impacts is seen as the core process contributing to lives compromised by shame, even if we do not imagine those lives to be suffering from shame as such: “Following an unrepaired mismatch of need and response, a disintegration of self may be masked, but it is painfully real…” (24).
DeYoung outlines how misattunement gives rise to long-term damage to our relational capacities and expectations of others. Among other losses, those who experience profound or ongoing misattunement become limited in what we form, seek or hope for, particularly when it comes to expressing need. Instead we may come to loathe, reject or disavow our needs, based on an implicit knowing that we must be unworthy of being related to, toxic or disgusting, and that we should be ashamed of something basically human within us:
...what the child misses is a sense of communion or affective sharing, an experience of relatedness in which there is no discrepancy between infant and caregiver. Thus Bacal calls shame the affect of discrepancy – first, the discrepancy between a child’s emotional needs and the capacity of people in his environment to respond to them. Shame also lives in the discrepancy between any person’s longing for primary relatedness and his failure to experience it…
(DeYoung, 2015: 24)
As I hope I am managing to convey, I found this book personally revelatory and provocative, as well as educational (and sometimes devastating) in lots of small ways. One conceptual piece which stood out was a discussion of the importance of parents “reflecting a child as both subject and object, so a child has a chance to learn both ways of being in the world…” (DeYoung, 2015: 26). DeYoung notes how we need to be related to both as beings with inner experience that matters, and with capacities and qualities which impact life and others. This is an important reminder, and an invitation to all of us to develop the
fluidity between these two modes of mirroring and self-perception, as so many imbalances are amplified by leaning too exclusively toward either objectification of the self or the kind of self-absorption and indulgence that only relates to our subjectivity. In terms of early life, the subjective element is most essential, because “[When objectification dominates] the child loses the possibility of recovering what Francis Broucek calls primary communion with others….” (DeYoung, 2015: 26). This capacity for primary communion – and the therapeutic task of recovering it, is a central preoccupation of DeYoung’ s book:
…in the absence of person-to-person (inter-subjective, right brain connection), there will be affective dysregulation, and selves will feel themselves disintegrating…family members will feel shame when what they need to feel human is withheld and there is absolutely nothing they can do about it. In those “falling apart” moments, rage feels better than shame. In many family systems, chronic rage covers for chronic shame. Depression is the other side of the coin…giving up on connection without the show of taking power…
(DeYoung, 2015: 65)
The second part of the book looks at working with shame in the therapy context. It will come as no surprise that what shamed clients benefit from is attuned, sensitive relationship in the form of “a sustained experience of being empathically understood” (DeYoung 2015: 92).
…we hope that they see in our eyes that their subjective emotional self exists and that it matters. For clients whose early caregivers were neglectful, distracted by anxiety, or abusive, this may be something they need more than they could ever consciously know…
(DeYoung, 2015: 92; emphasis in original)
Unsurprisingly, DeYoung advocates that therapists befriend their own shame. As therapists who have become comfortable with and more available to our own shame experience, the overlay of self-rejection and curtailed relational capacity which often hold shame in place is undermined. When we are neither relationally ashamed of our shame, enacting a defence against it, nor physiologically dysregulated in its presence, the part of us that has held and befriended our shame becomes increasingly available as a resource for others.
DeYoung’s reference points will probably sit comfortably with many IAHIP practitioners: she draws frequently on self-psychology, attachment theory, and object relations, alongside more contemporary perspectives (particularly the work of Allan Schore and Louis Cozolino) in chapters such as ‘Narrative as right brain integration’ and ‘Shame and the relational brain’. Although DeYoung’s book is not as comprehensive as David Wallin’s brilliant Attachment in psychotherapy, I felt it to have a similar capacity to integrate and clarify more traditional therapeutic perspectives alongside emergent ones from neuroscience and right-brain therapy. The tone is accessible, humanist, and practical, but the theory is also substantial, sophisticated and thorough. DeYoung has clearly wrestled to understand shame experience for long enough that she brings clarity and genuinely synthesising understanding to the territory, alongside a complete absence of pretension. Her discussion of different theoretical models, and capacity to represent the nuances each capture, is a real gift to those of us familiar with the schools of thought she draws on, yet who do not know what specifically each might bring to the theme of shame:
This is one of Schore’s pictures of shame: a parasympathetic low-arousal state that has the behavioural analogue of hiding and the cognitive analogue of seeing oneself as a failure…” or, “ Shame is not about the absence of the other, but about something wrong with presence at a time when a child needs a particular kind of response.
(DeYoung, 2015: 41)
Or, quoting Francis Broucek: “felt inefficacy in relation to the human environment is what
(DeYoung, 2015: 25)
One of the reasons this book is rich is because it weaves and loops over the relational landscapes formed by shame, capturing in precise yet accessible ways how relational capacity can be deeply compromised by shame, alongside an expertise in masking our limitations. In this we may recognise both ourselves and our clients, and Understanding and treating chronic shame is a book that has the capacity to nourish our clinical work both through its holding of us as human readers, and through heightening our awareness of the different ways our clients may defend against conscious shame yet carry its impacts still.
I often find when I read clinical books that they are either too heavily theoretical or too reliant on narrative vignettes from client work. This is neither. DeYoung covers her subject from a multiplicity of angles, and includes clinical material, but we don’t feel conceptually flooded because the concepts are applied and articulated in grounded and credible ways.
DeYoung’s work, published in 2015, comes at a time when we may be open to its message and able to absorb much of it quite intuitively. It seems that culturally we are ready to integrate experiences like shame with less resistance than in the past. DeYoung notes this too, referencing the popularity of Brene Brown’s popular self-help books (DeYoung, 2015: 3)
From my own perspective, one of the ways our culture is evolving relates to how many therapists and clients now practise some form of meditative awareness or somatic practice alongside their therapeutic process. One of the real gifts of combining psychotherapy with an awareness practice based on embodied presence is how much previously toxic relational experience can now be tolerated and experienced phenomenologically and physiologically within ourselves as well as in the relational environment of psychotherapy. This enables us to develop our capacity to meet and explore experiences such as shame with more space and less identification, dismay – and shame. We learn to slow things down and to notice and to bear the processes in play without experiencing them only through a relational lens. This allows us to become gradually familiar with experiences that can feel relationally like emergencies, allowing, over time, for substantial development in our capacity to, in Winnicott’s phrase, go on being. Over time this relaxes our capacity to be with shame (or any other state), whether alone or in relation.
This is a deeply sincere, humane book, and one that may be accessible to psychologically minded clients and non-professionals. I’ve shared it with a number of friends in Ireland and abroad who are, like many of us, narcissistically wounded in some form, and each has found it accessible, enriching, and strikingly revelatory. If I was to have a caveat, it would be that sometimes the theme of chronic shame seems almost too specific for the territory covered. In one sense ‘chronic shame’ is just the organising idea through which DeYoung explores our profound need for regulation and attunement and the impacts and aftermath of dysregulation. (If I could give the book a new subtitle, it would be Failure of attunement and its discontent(s) and aftershocks.)
I think there may be many of you who will, like me, read this book first with swathes of self-recognition – threads of our experience are magnified, heightened, clarified – and later return to it with a view to the wider field of theory and to our clients. I am not assuming we all suffer from chronic shame, but as therapists – and DeYoung notes this – many of us treasure attunement precisely because we know what its absence feels like, and how precious and reparative it can be. As William Blake writes, capturing beautifully the task of recovering relational capacity: “And we are put on earth a little space, That we may learn to bear the beams of love…. “ (Blake, 2015: 102) This is the territory DeYoung invites us to inhabit, both for ourselves and for our clients.
Emma Philbin Bowman has a private practice as a psychotherapist, writer and lecturer, and offers themed workshops on therapeutic and spiritual themes, including shame. She has a background in philosophy and is deeply influenced by Buddhism, the practice of meditative inquiry, and by contemporary mystic Thomas Hubl. www.emmapb.com email@example.com
DeYoung, P. A. (2015). Understanding and treating chronic shame: A relational/ neurobiological approach. New York: Routledge.
Wallin, D. (2007). Attachment in psychotherapy. New York: Guildford Press.
Blake, W. (2015). Collected poems. Omaha: William Ralph Press.
Winnicott D.W. (1960). The theory of the parent-infant relationship. International Journal of Psychoanalysis, 41, 585-595.